Fistuloplasty & venoplasty

gayathria

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Please help me with CPT's


fistulography and fistuloplasty on left brachiocephalic fistula was done

venography of the right and left brachiocephalic veins was performed. CPT-75820?

venoplasty in right brachiocephalic vein was done. CPT- 37248 ?
 

thomas7331

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It's hard to say for sure without seeing the operative report, but is this an angioplasty of a dialysis fistula? If so, then 37248 would not be correct - the appropriate codes are in the range 36901-36909 for interventions to a dialysis circuit. The brachiocephalic portion is considered part of the central segment, in which case this would be coded as 36901 (for the fistulography), with add-on code 36907 for the intervention. The venography would be inclusive and not separately reported, if I remember correctly.
 

gayathria

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Procedure: Fistulography, Fistuloplasty of the left brachiocephalic fistula, Venography and venoplasty of the right brachiocephalic vein/stent
Medication: as per anesthesia.
Description :
using the existing access , new 7 F sheath was introduced.
fistulography showed no flow in the fistula. Juxtra anastomotic tight anastomosis, two further tight anastomosis in the cephalic vein.

fistuloplasty with 5 mm x 60 mm high pressure balloon, followed with 5 mm x 120 mm Drug coated balloon, 6 mm x 40 mm high pressure balloon.
5 mg alteplase was also administered.
unfortunately no improvement in the flow was demonstrated.

Referral to vascular surgery is advised for either new fistula formation or revision of the fistula is advised.

venography of the right and left brachiocephalic veins was performed showing good result post EKOS thrombolysis with residual narrowing in the right brachiocephalic stent.
venoplasty with 10 mm x 40 mm and 12 mm x 40 mm high pressure balloon was performed with satisfactory result.
 

such78

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Procedure: Fistulography, Fistuloplasty of the left brachiocephalic fistula, Venography and venoplasty of the right brachiocephalic vein/stent
Medication: as per anesthesia.
Description :
using the existing access , new 7 F sheath was introduced.
fistulography showed no flow in the fistula. Juxtra anastomotic tight anastomosis, two further tight anastomosis in the cephalic vein.

fistuloplasty with 5 mm x 60 mm high pressure balloon, followed with 5 mm x 120 mm Drug coated balloon, 6 mm x 40 mm high pressure balloon.
5 mg alteplase was also administered.
unfortunately no improvement in the flow was demonstrated.

Referral to vascular surgery is advised for either new fistula formation or revision of the fistula is advised.

venography of the right and left brachiocephalic veins was performed showing good result post EKOS thrombolysis with residual narrowing in the right brachiocephalic stent.
venoplasty with 10 mm x 40 mm and 12 mm x 40 mm high pressure balloon was performed with satisfactory result.
36901 and 36908

36901 - fistulography showed no flow in the fistula.

36908 - is an add-on code, has to use with 36901 -36905. In this case, balloon angioplasty and stent were done in brachiocephalic as central segment.
 
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thomas7331

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I would code this as 36901 and 36907 because there is no documentation of a stent placement at this encounter. By my reading of the report, it seems that the stent was already in place, perhaps from a previous intervention. You may want to query the provider for clarification on this though.
 

such78

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I would code this as 36901 and 36907 because there is no documentation of a stent placement at this encounter. By my reading of the report, it seems that the stent was already in place, perhaps from a previous intervention. You may want to query the provider for clarification on this though.
Thank you for correction. I read it wrong.
 
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